Developing a federated model of General Practice - Providers & commissioners working together in collaboration

Developing a federated model of General Practice - Providers & commissioners working together in collaboration

3rd July 2014

Developing a federated model of General Practice - Providers & commissioners working together in collaboration

A balanced and viable health economy is a statutory duty
for a CCG, and my view remains the best way to achieve that
outcome is for commissioners and providers to collaborate with
the same goal in mind - a balanced and viable health economy.

As discussed in previous issues, the new contracting
opportunities available, in prime, principle and alliance
contracts lend themselves to this approach.

Why then is it that I regularly come across CCGs (not all
by any means - there are some great examples in my work of
fantastic engagement from CCGs) completely paralysed at the
thought of speaking with or engaging with a
GP Federation? I need to explain here
that engagement is not meetings - I can get as many meetings
as I want; engagement is "an arrangement to do
something or go somewhere at a fixed time" for me the
key point is the statement "to do something".

That something for me should be to
collaborate (collaborate meaning "work jointly on an activity
or project") on developing services, which make the appropriate
shift from in hospital to out of hospital care, which of
course is where the new contract options come in. Additionally,
by including all possible providers in the collaboration we
avoid/reduce conflict of interest problems, by ensuing
everyone has a say.

Keep in mind at the end of the day whatever work and ideas
are produced it is down to the CCG to develop the service
specifications, not the work group, which of course means
ultimately it is the CCG who remain the decision making body on
what to commission and the procurement route to go.

Given the current financial position within the NHS, and the
significant challenges we now face in the next 3 years, the newly
emerging GP federations offer significant opportunity for CCGs.
That opportunity though can only be realised where the CCG is
willing to take a small risk and take the leap of faith that
working in collaboration across providers is not going to see them
facing challenges from those providers. The reason I say that is
the other providers should of course be involved in the
collaboration.

One health economy with one budget is surely now the way
forwards, with a focus on placing the patient in the most
appropriate setting for the level of care they require, with
the healthcare professional best placed to deliver that care
available in the location.

Interestingly those CCGs where there is no engagement are
often the only group missing from the federation meetings, as
it is now commonplace for the federations to work with the
local FT, Community Services, Community and Voluntary Sector, Local
Authority, Social Care etc. So common that many we support are
now developing strategic partnership agreements and I have now
been able to secure subcontracted work for federations from
those other providers.

"Far better is it to dare mighty things, to win glorious triumphs,
even though checkered by failure than to rank with those poor
spirits who neither enjoy much nor suffer much, because they
live in a gray twilight that knows not victory nor defeat." -
Theodore Roosevelt, 26th U.S. President.

This quote has never been more applicable than now; the CCGs not
engaging can carry on as they are and many will end up over
the abyss (instead of just staring in to it) or they can drive
through clinical change.

To answer another prominent bloggers question, "what does the
NHS need to change in to"? The NHS doesn't need to change in
to anything, what it requires to remain the NHS as we know it,
free at the point of access, is clinical change, with
investment, real investment, in General Practice, via
federations which work at scale and pace, to deliver
high quality services, consistently well over all practices by
having people work to agreed thresholds and standards.
Those thresholds and standards simply require the right
balance between standardisation and consistency, while
also allowing for local empowerment and flexibility. Above all
they require accountability from federation to practice for
the services and outcomes, something those we support are
comfortably achieving without the need for threats
and/or confrontation.

It's not rocket science, but I am not sure CCGs unwilling
to engage in "doing" will see it that way. I still see
many instances daily of people creating bureaucracy for the
sake of it, hiding behind "the system" rather than working to
challenge the ways of the past and the system they work within.
Time for some foresight and CCGs owning, driving and recreating
their local system, not having one imposed that they maintain and
then blame.

For more information on how BW Medical Accountants can support
you in forming a federation, or to arrange to speak to one of our
experts please contact enquiry@bw-medical.co.uk or
call 0191 653 1022.

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